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ST. LOUIS • A trial started here Tuesday in U.S. District Court that will determine if the treatment at a controversial Missouri Department of Mental Health program for sexually violent predators is constitutional.

Seeds for the case were planted in 2009, when a handful of men — civilly committed against their will to the maximum security Sex Offender Rehabilitation and Treatment Services, or SORTS, facility in Farmington — wrote out legal claims by hand. They were being billed by the state for care and treatment that they didn’t want to be a part of at SORTS.

The Eastern District of Missouri eventually assigned the case to a lead litigator at the Clayton-based law firm Armstrong Teasdale, who, over time, broadened the case to a class action lawsuit that alleges SORTS is a prison disguised as a mental health hospital. The firm says it has since put “millions” of dollars worth of time into the case.

With the help of the American Civil Liberties Union of Missouri and others, plaintiffs’ attorneys sought and sifted through about 1 million pages of internal emails, memos and other documents associated with the SORTS program.

“This is an important case,” plaintiffs’ attorney Jack Quinn said during opening statements. “It’s an important day.”

Following the lead of other states, the Missouri law seeks to identify sexual predators nearing the end of their prison sentences. It then lays out a process for civil courts to decide if they need to be locked up further, but in treatment. The statute sets no time limit on confinement, saying the treatment should continue until the risk falls to acceptable levels.

Some states have shown that patients can be moved through treatment and be released into the community. But Quinn argued that Missouri is “warehousing” people due to poor management and a politicized legal road to SORTS.

So far, he said, the only way out has been to die. Since state lawmakers created the program in 1999, Quinn told the court, nobody has been released into the community for successfully completing treatment at SORTS.

In some cases, the attorney general’s office has indefinitely committed patients to SORTS when Department of Mental Health experts said they didn’t meet the requirements to be in its own facility.

“Let’s be honest, they are shunned by society,” Quinn said of this particularly egregious group of sex offenders, adding: “We think that affects their liberty interests.”

There are 206 people in the SORTS program. Most live in Farmington on a red brick campus hemmed in by double fences topped with spools of razor wire. The program has been expanded in recent years to include placement at Fulton State Hospital. About 20 people are added each year, though civil commitment hearings have been put on hold leading up to the start of the federal trial here, which is expected to last two weeks.

The Missouri attorney general’s office, which is defending the state, told the court Tuesday that the legality of SORTS is sound.

The “treatment meets the constitutional requirements, but also represents the best practices for the treatment of sexually violent predators,” said Philip Sholtz, of the attorney general’s office, during his brief opening statement.

He argued that sexually violent predators are some of the most difficult patients for psychiatrists to treat. He said the field — a mixture of law and science — is still in its infancy and that patients often resist treatment.

“SORTS faces a monumental task,” Sholtz said.

While there have been questions raised about treatment, he said, SORTS had been accredited as a hospital. An annex has been built in the Farmington facility that’s still inside the razor wire but allows more freedom for people progressing though the program.

The U.S. Supreme Court has upheld the constitutionality of the civil commitment process used by Missouri and 19 other states and the federal government. But the process has been hammered by a barrage of lawsuits and critics, who say it corrupts the concept of court-ordered mental health treatment.

The Missouri attorney general’s office argues that many of the issues have already been raised here.

U.S. District Court Judge E. Richard Webber weighed complaints and concerns about treatment in a Civil Rights Act case brought by a SORTS resident, also first written out by hand. In the 2010 decision, Webber wrote that some treatment at SORTS likely fell below professional standards but not enough to “shock the conscience” to be declared constitutionally inadequate.

At the beginning of the case Tuesday, Quinn argued that SORTS hasn’t made enough improvements in the past six years. He referenced an expert’s report that the defense had brought, who mentioned “systematic difficulties.”

The expert, Anita Schlank, wrote in a Feb. 15 report about SORTS: “While much about the Missouri (sexually violent predator) program is quite consistent with components of other SVP programs, it is concerning that in fifteen years no client has been conditionally released into the community. This fact has led to a sense of hopelessness, not only in clients, but also in staff.”

She added in the last line of the report: “However, it does not appear accurate to claim that the program has substantially departed from accepted standards in the field of residential sex offender treatment.”

Schlank is expected to testify at the trial being heard by U.S. District Court Judge Audrey G. Fleissig.